摘要
目的 探讨麻醉前静注右美托咪定(dexmedetomidine,Dex)对腰硬联合麻醉下剖宫产产妇与新生儿的影响.方法 选取美国麻醉医师协会(ASA)分级为Ⅰ或Ⅱ级、拟在腰硬联合麻醉下接受择期剖宫产的足月临产妇90例,使用随机数字表法将其随机分为3组,每组30例:A组静脉给予生理盐水;B组静脉给予Dex 0.5 μg/kg;C组静脉给予Dex 1 μg/kg.观察静脉输注试验药物前(T1)、输注开始后5(T2)、10(T3)、15(T4)、20 min(T5)及胎儿娩出时(T6)产妇的平均动脉压(mean artery perssure,MAP)、心率(heart rate,HR)、脉搏血氧饱和度(pulse oxygen saturation,SpO2)、Ramsay镇静评分;记录感觉阻滞起效时间、持续时间、最高平面及达到最高平面时间和运动阻滞起效时间、持续时间、最高评分及达到最高评分时间;胎儿娩出断脐后立刻抽取脐动脉血进行血气分析和乳酸测定,记录新生儿出生后1、5 min时Apgar评分;评价并记录出生后2、14 d时新生儿神经行为学(neonatal behaviral neurological assessment,NBNA)评分. 结果 C组患者T2~T6时Ramsay评分显著高于A组和B组,MAP、HR、SpO2显著低于A组和B组(P<0.05).A组、B组、C组的感觉起效时间、持续时间、最高麻醉平面中位数(T)、达到最高平面的时间分别为(5.5±1.9) minvs (3.9±1.5) minvs (3.9±1.6) min、(80.1±13.4) min vs(92.0±14.5) min vs(91.3±15.5) min、T5(T6,T4)vs T4(T4,T3)vs T4(T4,T3)、(13.2±3.2) min vs (10.4±1.9) min vs(10.2±2.5) min,A组与B组、C组比较,差异均有统计学意义(P<0.05).A组、B组、C组的运动起效时间、恢复时间、运动阻滞最高评分的时间为(4.2±1.7) min vs(3.3±1.4) min vs(3.1±1.2) min、(84.5±10.4) min vs (95.6±14.3) min vs (98.3-±12.3) min、(16.5±5.8) min vs (13.3-±2.7) min vs(12.4±2.7) min,A组与B组、C组比较,差异均有统计学意义(P<0.05).3组之间新生儿脐动脉血气、乳酸值和出生1、5 min时Apgar评分以及出生后2、24 d时的NBNA评分差异无统计学意义(P>0.05). 结论 腰硬联合麻醉前应用Dex可以产生良好的镇静作用,缩短腰硬联合麻醉起效时间、延长持续时间,且对新生儿Apgar评分和NBNA评分无副作用;其中0.5 μg/kg Dex对产妇血流动力学影响小于1 μg/kg.
Objective To investigate the effects of dexmedetomidine (Dex) on cesarean delivery women and newborn undergoing combined spinal-epidural anesthesia.Methods Ninety ASA Ⅰ-Ⅱ full-term pregnancy women who underwent elective cesarean section were randomly divided into 3 groups(n=30):control group (group A) and Dex group (group B and group C).Dex was respectively infused intravenously at 0.5 μg/kg in group B and 1 μg/kg in group C while in group A equal volume of normal saline was infused instead of Dex.The maternal mean arterial pressure (MAP),heart rate (HR),pulse oxygen saturation(SpO2),Ramsay scores of mothers were recorded at six time points:before iv(T1),5 min after iv(T2),10 min after iv(T3),15 min after iv (T4),20 min after iv (T5) and the neonate was delivered (T6).Sensory block onset time,duration,the highest level,the time required to achieve the highest level were also recorded,as well as motor block onset time,the highest scores,the time required to achieve the highest scores.Umbilical arterial blood was obtained immediately after breaking the umbilical cord for analysis of blood gas and lactic acid.Apgar scores 1 min and 5 min after labor were recorded,and neonatal behavioral neurological assessment (NBNA) scores 2 d and 14 d after labor were evaluated.Results Ramsay scores were significantly higher,MAP,HR,SpO2 were lower in group C than in group A and B(P〈0.05).Sensory block onset time,duration,the highest level median,the time required to achieve the highest level of group A,group B,group C were respectively as follows:(5.5±1.9) min vs (3.9±1.5) min vs (3.9±1.6) min,(80.1±13.4) min vs (92.0±14.5) min vs (91.3±15.5) min,5.5 (6,4) vs 4 (4,3) vs 4 (4,3),(13.2±3.2) min vs (10.4±1.9) min vs (10.2±2.5) min.The differences were statistically significant (P〈O.05) compared with group A.Motor block o nset time,the highest scores,the time required to achieve the highest scores of group A,group B,group C were respectively as follows:(4.2±1.7) min vs (3.3±1.4) min vs (3.1±1.2) min,(84.5±10.4) min vs (95.6±14.3) min vs (98.3±12.3) min,(16.5±5.8) min vs (13.3±2.7) min vs (12.4±2.7) min.The differences were statistically significant compare with group A(P〈0.05).There was no significant differences in umbilical arterial blood gas analysis,lactic acid,Apgar Scores and NBNA scores among the 3 groups (P〉0.05).Conclusions Dex can provide good sedation,shorten onset time of spinal anesthesia and extend the blocking duration with no adverse effects on Apgar scores and NBNA scores before employing combined spinal-epidural anesthesia.The effect on maternal hemodynamics was less at 0.5 μg/kg than 1 μg/kg of Dex.
出处
《国际麻醉学与复苏杂志》
CAS
2014年第6期510-514,共5页
International Journal of Anesthesiology and Resuscitation
基金
上海市嘉定区科学技术委员会科研项目(201123)
关键词
右美托咪定
腰硬联合麻醉
剖宫产
临产妇
新生儿
Dexmedetomidine
Combined spinal-epidural anesthesia
Cesarean delivery
Parturient
Newborn